Provider Demographics
NPI:1538231451
Name:DOUGLASS, M ELIZ (PHD)
Entity type:Individual
Prefix:DR
First Name:M ELIZ
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:DOUGLASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:10985 N POINSETTIA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-6695
Mailing Address - Country:US
Mailing Address - Phone:520-469-7977
Mailing Address - Fax:
Practice Address - Street 1:10985 N POINSETTIA DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-6695
Practice Address - Country:US
Practice Address - Phone:520-469-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3349103TC0700X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60681OtherMEDICARE PART B